Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition

Bull World Health Organ. 1993;71(1):79-92.


Infections and the malnutrition associated with them are responsible for a significant proportion of the 13 million deaths among infants and children under 5 years of age worldwide each year. After respiratory infections, diarrhoeal diseases are the commonest illnesses and have the greatest negative impact upon the growth of infants and young children. The causes of diarrhoeal diseases have traditionally been ascribed to water supply and sanitation. In attempts to prevent such diseases, efforts by governments and nongovernmental organizations have been focused on and sometimes limited to improving water supply and sanitation as well as promoting and protecting breast-feeding. Based on studies reported in the literature, this review article demonstrates that weaning foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and thus are a major factor in the cause of diarrhoeal diseases and associated malnutrition. In the light of the evidence presented, it appears that current efforts are not sufficient to prevent diarrhoeal diseases: education of mothers in food safety principles, particularly weaning food, must also receive high priority. Educational programmes based on the hazard-analysis-critical-control-point approach, taking into consideration also sociocultural factors, should be integrated into all national infant feeding or food and nutrition programmes.

PIP: Even though contaminated foods are responsible for up to 70% of diarrheal episodes, efforts to prevent diarrheal diseases often overlook food safety. Food safety is at least as important as breast feeding or providing a safe water supply and sanitation services. In developing countries, weaning foods are often prepared in an unhygienic manner. Thus, the weaning age is an especially dangerous time for infants since they are exposed to infective doses of foodborne pathogens. Infections caused by pathogenic Escherichia coli is probably responsible for as much as 25% of all diarrheal episodes in developing countries. E coli is often linked to weaning foods. Other significant microbial infections causing diarrhea include shigellosis and cholera. Rotavirus most frequently attacks 6-24 month olds and causes 20% of all diarrheal deaths among those under 5 years old. Foodborne infections can have dangerous and longterm effects, especially on nutritional status. In fact, the resistance of infants suffering from nutritional deficiencies is suppressed, leaving them wide open to infectious diseases, particularly those causing diarrhea, which further reduces their ability to fight disease. They then become progressively more malnourished. Food contamination sources include unclean hands, feces, polluted water, flies, pests, domestic animals, unclean utensils and pots, and an unsanitary environment. Cross-contamination during food preparation is also responsible, e.g., contact between raw and cooked foods. Beliefs and practices, ignorance, taboos, poverty, insufficient food, social infrastructure, and shortage of fuel and time often make it more difficult to assure food safety. Food safety could reduce hospital costs since diarrhea is the leading reason for hospitalizations among children. Food safety education for mothers in primary health care and infant feeding programs is the most important intervention in promoting the health and nutritional status of infants and children.

Publication types

  • Review

MeSH terms

  • Adult
  • Culture
  • Diarrhea, Infantile / etiology
  • Female
  • Food Contamination*
  • Food Handling / standards
  • Health Education
  • Humans
  • Infant
  • Infant Food*
  • Infant Nutrition Disorders / etiology*
  • Mothers / education
  • Risk Factors
  • Socioeconomic Factors
  • Weaning